(精选)【持续性肾脏替代治疗CRRT英文精品课件】CRRT-Continuous Renal Replacement Therapy教学课件.pptVIP

Describe flow paths on slide. Note: Point out again that … Replacement fluids may be administered either pre or post filter. We will discuss these options later in the program. Predilution: run alternately as followed via artery end? 信東CVVH Solution A 3000 cc + KCl (?? ) cc run 500 ml/hr? 信東CVVH Solution B 2760 cc + 7% NaHCO3 250 cc run 500 ml/hr Dialysate: ?? 信東CVVH Solution A 3000 cc + KCl (?? ) cc run 500 ml/hr??? 信東CVVH Solution B 2760 cc + 7% NaHCO3 250 cc run 500 ml/hr Warm Predilution Dialysate to 37.0 ℃ Record I/O BP Q1H UF target: I-O = ( )cc/hr Monitor: BUN, Cr, Na, K, Cl Q12H x 1 day and then QD Ca, P QD; Mg QW1,4 aPTT Q6H if heparin use 使用信東CVVH Solution A B CRRT的併發症 常見併發症 1.出血 2.血腫 3.血栓 4.感染和敗血 5.過敏反應 6.低體溫(失溫) 7.營養流失 8.血液淨化不足(backfiltration) 9.血壓下降 10.心律不整 11.Air embolism ?? 常見問題 UF不順 (拉不出來) Tube比AK早clot (常見) D/L紅端拉不出血 低血鉀 低體溫 低血壓、心跳變慢 換一支吧… 可先換管路… AV change or 換D/L 加KCl於A液中 加熱，太陽! Bye~死心吧! Finally … HD vs CRRT Outcome and Mortality ?? No difference !! JAMA critical care medicine, 2008 Note that this schematic indicates the addition of a REPLACEMENT FLUID. The replacement fluid-usually composed of approximate normal plasma values- enters the blood flow path as it circulates through the hemofilter. This not only has a dilutional effect on the blood but enables us to remove large volumes of water into the waste without dehydrating the patient or causing other hemodynamic shifts. Using the principles we discussed, pressures in the system can be adjusted to regulate ultrafiltrate volume. How much clearance of small/midsize molecules will be influenced both by the composition of the replacement fluid, and the amount of fluid we “replace” or force to cross the membrane into the waste collection. Note that replacement fluids may be administered pre or post filter. We will discuss these choices in a few moments. Describe flow paths on slide.